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VP of Provider Networks & Operations

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POST DATE 8/31/2016
END DATE 12/19/2016

MMS Group Syracuse, NY

MMS Group
Syracuse, NY
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #


VP of Provider Networks & Operations -UPSTATE NY

.Rewarding opportunity to develop a truly collaborative relationship with provider networks and implement successful programs to improve outcomes and quality. Vice President provides the strategic direction and the operational leadership to drive growth and meet financial performance objectives for the assigned market. VP will have oversight for all operations with focus on the contracting, recruitment, retention, and management of the provider networks and all provider relations areas. VP will have P&L responsibility for the product in this market, including oversight for medical management.


* Lead all aspects of provider and network operations to include provider network strategy, provider relations and operations to support provider service, network development, provider education, and product and market expansions
* Develop market level strategy and annual business plan to achieve quality, financial and clinical performance objectives.
* Negotiate and maintain product-wide provider contracts with financial and other terms that are competitive.
* Provide the appropriate level of oversight to ensure compliance with all CMS and state insurance department regulations governing the Medicare Advantage products.
* Achieve and maintain very strong business relations with providers of contracted administrative services, medical care providers and sales distribution channel, regulators and other key customer groups.
* Design and execute revenue and member growth strategies.
* Collaborate with the STARs and Compliance team in maintaining a highly effective quality compliance program covering all areas required to meet internal organizational objectives and to achieve compliance with HEDIS, CMS and other regulatory requirements.
* Works cross-functionally to facilitate new market and new product implementations.

Ideal Profile (Education and Credentials)
* Bachelor's degree - Master's degree preferred
* 8+ years of successful health plan leadership, performance achievement, and network development experience in a health plan or managed care organization
* 4 + years of experience with government programs
* Must have proven success in developing provider networks and managing risk arrangements.
* Prior P & L and/or product ownership